Undertake ENT operations for COVID-19 patients only in emergency cases: Health Ministry

Underlining that ENT surgical procedures are associated with very high transmission risk of COVID-19, the Union Health ministry on Wednesday said coronavirus infected patients should be operated in designated operation theatres only in emergency cases.

In case of pre-operative COVID positivity, a surgeon should weigh the risk benefit of postponing surgery for 14 days or scheduling procedure in COVID-designated operation theatre, said the 'Guidelines for safe ENT practice in COVID 19'  released by the ministry on Wednesday.

Stating that ear, nose, throat (ENT) is a high-risk speciality, the ministry said the guidelines are aimed at minimising the spread of COVID-19 infection among ENT doctors, nursing staff, support staff, patients and their attendants.

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Highlighting that tele-consultation will be preferable, the ministry said all patients entering ENT OPD should be screened and should undergo thermal screening.

The objective of screening is to minimize exposure to staff and to patients. Patients having symptoms suggestive of COVID-19 (whether ENT or respiratory symptoms) should be seen in a separate "COVID-19 screening Clinic" and not in the ENT OPD, the guidelines stated.

The guidelines said the ENT OPD room should be well-ventilated and doctors should wear Level I PPE kit (N95 mask, gown, gloves, goggles/ face shield) in the chamber.

They should avoid performing endoscopy in routine OPD  but if at all it has to be performed, it should preferably be performed in a separate demarcated area with Level II PPE kit (cover-all gown, N-95 mask, gloves and goggles).

Listing the protocols for ENT and head and neck surgery ward, the ministry said the aim of guidelines is to maintain it as a COVID free ward as possible and suspected patients should be treated in a separate ward for COVID patients while they should be shifted to the ward only after confirmation of their negative status.

Patients should be screened for COVID 19 before admission. Suspected and confirmed cases of COVID-19 patients should be kept separately and all precautions for COVID 19 like wearing of mask, frequent hand washing and social distancing should be strictly followed.

"Visitors should not be allowed and distance of at least two meters in between patient beds is mandatory. Additional distance if feasible is desirable as care taker may also be accompanying patients.

"Ward should be demarcated into separate areas for patients with high aerosol generating potential (e.g. Tracheostomized patients) and for ENT patients," the document stated.

According to the document, major bulk of aerosol-generating patients in ENT are tracheostomized patients.

Tracheostomy tube suctioning or change, nasogastric tube insertion and procedures in nasal and oral cavity such as examination, cleaning, suctioning, nasal packing, foreign bodies' removal etc are also common aerosol-generating procedures.

Environment surfaces of ENT facilities should be cleaned with water and detergent and by applying commonly used hospital disinfectants such as sodium hypochlorite to keep wards COVID-free, it said.

To escalate the preparedness towards reinstating operation theatre (OT) practices for ENT surgeries in the wake of COVID-19 pandemic, the ministry said, "No COVID positive patient to have surgeries in OT designated for non-COVID case and positive patients to be operated only for emergency indications in designated OT for COVID patients."

ENT surgical procedures are associated with very high transmission risk of COVID-19 as the upper aerodigestive tract is the post of entry, nidus and exit route for the novel coronavirus and there is high aerosol generation during surgeries in the upper aerodigestive tract.

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